Healthcare Provider Details

I. General information

NPI: 1932454238
Provider Name (Legal Business Name): BETH ANNE BARKER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE STREET
CHARLESTON SC
29401
US

IV. Provider business mailing address

109 BEE STREET
CHARLESTON SC
29401
US

V. Phone/Fax

Practice location:
  • Phone: 888-878-6884
  • Fax: 845-791-7051
Mailing address:
  • Phone: 888-878-6884
  • Fax: 845-791-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401497-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number19737
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: